Kouz Karim, Monge García Manuel Ignacio, Cerutti Elisabetta, Lisanti Ivana, Draisci Gaetano, Frassanito Luciano, Sander Michael, Ali Akbari Amir, Frey Ulrich H, Grundmann Carla Davina, Davies Simon James, Donati Abele, Ripolles-Melchor Javier, García-López Daniel, Vojnar Benjamin, Gayat Étienne, Noll Eric, Bramlage Peter, Saugel Bernd
Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Unidad de Cuidados Intensivos, Hospital Universitario SAS Jerez, Jerez de La Frontera, Spain.
BJA Open. 2023 May 4;6:100140. doi: 10.1016/j.bjao.2023.100140. eCollection 2023 Jun.
Intraoperative hypotension is associated with organ injury. Current intraoperative arterial pressure management is mainly reactive. Predictive haemodynamic monitoring may help clinicians reduce intraoperative hypotension. The Acumen™ Hypotension Prediction Index software (HPI-software) (Edwards Lifesciences, Irvine, CA, USA) was developed to predict hypotension. We built up the European multicentre, prospective, observational EU HYPROTECT Registry to describe the incidence, duration, and severity of intraoperative hypotension when using HPI-software monitoring in patients having noncardiac surgery.
We enrolled 749 patients having elective major noncardiac surgery in 12 medical centres in five European countries. Patients were monitored using the HPI-software. We quantified hypotension using the time-weighted average MAP <65 mm Hg (primary endpoint), the proportion of patients with at least one ≥1 min episode of a MAP <65 mm Hg, the number of ≥1 min episodes of a MAP <65 mm Hg, and duration patients spent below a MAP of 65 mm Hg.
We included 702 patients in the final analysis. The median time-weighted average MAP <65 mm Hg was 0.03 (0.00-0.20) mm Hg. In addition, 285 patients (41%) had no ≥1 min episode of a MAP <65 mm Hg; 417 patients (59%) had at least one. The median number of ≥1 min episodes of a MAP <65 mm Hg was 1 (0-3). Patients spent a median of 2 (0-9) min below a MAP of 65 mm Hg.
The median time-weighted average MAP <65 mm Hg was very low in patients in this registry. This suggests that using HPI-software monitoring may help reduce the duration and severity of intraoperative hypotension in patients having noncardiac surgery.
术中低血压与器官损伤相关。当前术中动脉压管理主要是反应性的。预测性血流动力学监测可能有助于临床医生减少术中低血压。Acumen™低血压预测指数软件（HPI软件）（美国加利福尼亚州尔湾市爱德华兹生命科学公司）被开发用于预测低血压。我们建立了欧洲多中心、前瞻性、观察性的欧盟HYPROTECT注册研究，以描述在非心脏手术患者中使用HPI软件监测时术中低血压的发生率、持续时间和严重程度。
我们在欧洲五个国家的12个医疗中心招募了749例择期进行大型非心脏手术的患者。使用HPI软件对患者进行监测。我们通过时间加权平均动脉压<65mmHg（主要终点）、至少有一次动脉压<65mmHg持续≥1分钟的患者比例、动脉压<65mmHg持续≥1分钟的次数以及患者动脉压低于65mmHg的持续时间来量化低血压。
最终分析纳入了702例患者。时间加权平均动脉压<65mmHg的中位数为0.03（0.00 - 0.20）mmHg。此外，285例患者（41%）没有动脉压<65mmHg持续≥1分钟的情况；417例患者（59%）至少有一次。动脉压<65mmHg持续≥1分钟的次数中位数为1（0 - 3）次。患者动脉压低于65mmHg的持续时间中位数为2（0 - 9）分钟。
该注册研究中的患者时间加权平均动脉压<65mmHg的中位数非常低。这表明使用HPI软件监测可能有助于减少非心脏手术患者术中低血压的持续时间和严重程度。
